NPIMap

Organization Active NPI

Mountain States Cardiovascular and

  • Specialist
  • Idaho Falls, ID
National Provider Identifier
1306862503
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
M-6479 M-7194 Issued in ID
Legal business name
MOUNTAIN STATES CARDIOVASCULAR AND
Practice address
2225 Teton PLZ Ste B
Idaho Falls, ID 83404-6494
Phone
(208) 524-4660
NPI assigned
Jul 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lisa A Alcox
Title
Office Manager
Phone
(208) 524-4660

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X M-6479 M-7194 ID Primary

Addresses

Primary practice location

2225 Teton PLZ Ste B
Idaho Falls, ID 83404-6494

Mailing address

2225 Teton PLZ Ste B
Idaho Falls, ID 83404-6494
Phone (208) 524-4660

Other identifiers 2

IdentifierTypeStateIssuer
8A943OtherIDBLUE CROSS GROUP #
29390OtherIDBLUE SHIELD GROUP #

Other names 1

  • Mountain States Cardiovascular and Thoracic Surgery, PLLC Doing business as

National Provider Directory

National Provider Directory

Locations

2225 Teton Plz
Ste B
Idaho Falls, ID 83404
Phone (208) 524-4660

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1306862503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2225 TETON PLZ STE B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046494",
            "telephone_number": "208-524-4660",
            "fax_number": "208-524-4617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 TETON PLZ STE B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046494",
            "telephone_number": "208-524-4660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATES CARDIOVASCULAR AND",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ALCOX",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-524-4660"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "ID",
            "license": "M-6479    M-7194",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP #",
            "identifier": "8A943",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP #",
            "identifier": "29390",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain States Cardiovascular and Thoracic Surgery, PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.